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15例颅内泡型棘球蚴病的临床特点及手术疗效分析

Clinical Features and Surgical Outcomes of 15 Cases of Intracranial Alveolar Echinococcosis

    摘要
  • 摘要:
      目的  探讨颅内泡型棘球蚴病的手术治疗策略及临床疗效。
      方法  回顾性分析四川省人民医院和阿坝分院（阿坝藏族羌族自治州人民医院）神经外科2017年3月–2021年1月接受手术治疗且随访资料完整的15例颅内泡型棘球蚴病患者的临床资料，分析患者的临床和影像学特点、手术情况及疗效。
      结果  15例患者颅内病变总数共计50个，平均（3.3±3.1）个/例。颅内病变单发者4例；多发者11例，颅内病变数从2～13个不等。颅内病变单发患者均获得手术全切除。颅内多发病变的患者6例仅手术切除1个体积最大的病变，5例切除2～3个相邻病变。除1例患者外，其余14例患者均存在颅外病变，包括肝脏、肺部、肾脏、肾上腺及胸椎。患者术后随访时间12～58个月，平均（28.1±13.4）个月。13例随访时间内颅内情况稳定，2例深部病变伴蛛网膜下腔播散的患者颅内病变复发。2例患者随访过程中死亡。
      结论  显微外科手术治疗颅内泡型棘球蚴病疗效肯定，但是深部包虫病变特别是病变侵及蛛网膜下腔者，手术全切除困难。患者的预后与病变的范围及肝脏等全身包虫病变的控制情况密切相关。

     

    Abstract:
      Objective  To investigate the surgical treatment strategy of intracranial alveolar echinococcosis (AE) and the clinical outcomes.
      Methods  The clinical and follow-up data of 15 intracranial AE patients who underwent surgical treatment in the Departments of Neurosurgery of Sichuan Provincial People's Hospital (SPPH) and People's Hospital of Aba Tibetan and Qiang Autonomous Prefecture (a branch hospital of SPPH) between March 2017 and January 2021 were retrospectively analyzed. Full follow-up data were available for each of the 15 cases. The clinical and imaging characteristics, general surgical information, and surgical outcomes were analyzed.
      Results   In the 15 patients, there were a total of 50 intracranial lesions, with an average of (3.3±3.1)/case. Four cases had solitary intracranial lesions, while 11 cases had multiple lesions, with the number of intracranial lesions per case ranging from 2 to 13. All patients with solitary intracranial lesions received total resection. In 6 patients with multiple intracranial lesions, only the largest lesion was surgically removed, and in 5 patients, 2 to 3 adjacent lesions were surgically removed. All but one patient had extracranial lesions in their liver, lungs, kidneys, adrenal glands, and thoracic vertebrae. The patients were followed up for 12 to 58 months after surgery, with the mean follow-up time being (28.1±13.4) months. Among the 15 cases, 13 showed stable intracranial condition during postoperative follow-up. Intracranial lesions recurred in 2 patients who had deep lesions accompanied by dissemination to the subarachnoid space. Two patients died during follow-up.
      Conclusion  Microsurgical treatment of intracranial AE is effective, but total surgical resection is difficult to accomplish when patients have echinococcosis lesions located at a depth, especially when the lesions are spreading to the subarachnoid space. The prognosis of patients is closely associated with the extent of lesion invasion and the control of systemic hydatid lesions, especially those in the liver.

     

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